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News feature

Pharmacists asked to spread positive message about MMR vaccine by DoH

Vigorous efforts are being made by the Government to ensure that the public receives a clear and consistent message about the safety and effectiveness of the measles, mumps and rubella vaccine. Harriet Adcock reports on the part pharmacists are expected to play

Earlier this week, the Department of Health held a meeting as part of the Government's efforts to counteract negative publicity over the measles, mumps and rubella vaccine (MMR) and to update health care professionals on recent research. Controversy surrounding the vaccine began in 1998 when a study by Dr Andrew Wakefield and colleagues at the Royal Free Hospital, London, was published in The Lancet. The study described the case histories of 12 children who had behavioural problems and intestinal symptoms. In eight children the onset of behavioural symptoms was linked by the children's parents to the time at which the child received MMR. Since then, speculation over a link has been rife but no proof has been given to support the hypothesis that MMR causes autism.

A legal case being brought against the manufacturers of the triple vaccines by parents who believe their children have been damaged by MMR is expected to be heard in autumn 2003. With this on the horizon, the issues surrounding the safety of the vaccine are likely to remain in the public domain and, in the view of Government officials, it will be in the interest of claimants to continue to promulgate doubts over the safety of MMR.

The Department maintains that the triple vaccine is the safest way to protect children against measles, mumps and rubella. However, it recognises that the concerns of parents are real and that the consequences of children remaining unvaccinated could be serious. Some health care professionals and politicians argue that a solution would be to offer immunisation against the diseases using single vaccines and that if parents want the choice of single vaccines then the Government should give them this choice. The Government disagrees.

Dr David Salisbury, head of immunisation at the Department, said: "Turning to single vaccines would give credibility to the shadow of doubt being cast over MMR." He agreed that choice is an important part of National Health Service policy and practice. "When the choice is neutral this is right and proper. Choice between MMR and single vaccines is not neutral." Dr Salisbury went on to say that the NHS could not provide a vaccination programme that increases risk to children and unborn babies. He pointed out that a number of clinics were offering single vaccines privately and were giving the vaccines over short periods. "There is no evidence for the safety and efficacy of vaccines given in this way. ... The wild measles virus has an immunosuppressant effect. If the measles vaccine also has an immunosuppressant effect, giving them singly over a short period of time could be dangerous." Dr Salisbury would not be drawn on what a safe period might be. "We have no knowledge of what is safe in this regard," he said.

The Department called the meeting after launching an intensive media campaign on the triple vaccine earlier this month in an attempt to regain public confidence in the vaccine. It was clear from the tone of the meeting that the Department wants to enlist the help of local health care providers in delivering a positive message about MMR vaccine. Much emphasis was put on the value of talking directly to concerned parents and the need to get away from a didactic approach.

Steve Tomlin, principal paediatric pharmacist, Guy's and St Thomas' Hospital Trust, London, told The Journal that pharmacists at the hospital are being approached by parents and ward staff for advice about MMR.

"Most queries are simply what do you think about MMR and would you give it to your child? I go through the information and tell them that 'Yes, I would', and 'Yes I have had my child vaccinated with MMR'."

Mr Tomlin said he thought that parents were asking pharmacists, especially paediatric pharmacists, about MMR because they see pharmacists as drugs experts. "It is an important question. Pharmacists are asked because we know about drugs, and we should answer their questions." He added that he had not had many queries about the use of single vaccines and agreed that the Government's advice on this was sensible.

During the meeting, Dr Elizabeth Miller, head of the Public Health Laboratory Service immunisation division, reviewed the safety evidence for MMR and the studies which had fuelled the debate on a possible link with autism. A list of the studies and relevant publications is available in a health care practitioners' pack from Health Promotion England, which will be updated soon to include the latest research (see PJ, 9 February, p162 and 16 February, p198).

Joanne Yarwood, immunisation programme manager, Health Promotion England said pharmacists are encouraged to register for the pack through the HPE website.

Media campaign

Professor Sir Liam Donaldson, chief medical officer for England, said at the meeting: "The media has moved into full throttle, mostly in the absence of any new evidence. ... We now have anxious parents who have started to have doubts about a vaccine with a good safety record. ... If this was a criminal case it would be a serious miscarriage of justice ... the vaccine has been convicted on no sound evidence." He added that the media were also critical of the Government for its "unreasonableness" in not offering parents the choice of single vaccines.

This view that the media has taken a biased approach to the way it has been reporting the safety of MMR has been echoed in several medical journals. An editorial in last week's Lancet says: "Sadly, a balanced scientific debate has given way to personal attacks and unreasoned demands for single vaccines. ... Unless public opinion swiftly changes, measles, mumps, and rubella cases will become commonplace, with their resultant deaths and sometimes serious morbidity, mirroring the pertussis vaccine scare in the 1970s."

In the same issue, Professor John Walker-Smith, a senior clinician involved in the original Lancet study reported in 1998, endorses MMR but voices his concern that urgent research is needed to address the genuine fears of parents who associate MMR with the onset of autism.

Dr Salisbury sees the controversy over MMR and autism as a distraction. "Dr Wakefield's claims that a lot of inconclusive evidence put together results in strong positive evidence is naive. There is no rational case against MMR," he said. "The cost in research to prove negatives is gigantic and would be better put into autism research."

The Royal Pharmaceutical Society says in a statement issued this week that it continues to support the position held by the Department. It adds that pharmacists are well placed to offer information and support to parents who are concerned about vaccination, and can reassure parents about the safety of MMR. Pharmacists wanting to learn more about the issues relating to MMR are advised by the Society to visit the Health Promotion England website (www.immunisation.org.uk).